Marai Ibrahim, Haddad Rabea, Andria Nizar, Kinany Wadi, Hazanov Yevgeni, Kleinberg Bruce M, Birati Edo, Carasso Shemy
The Lydia and Carol Kittner, Lea and Benjamin Davidai Division of Cardiovascular Medicine and Surgery, Baruch Padeh Poriya Medical Center, Poriya 1528001, Israel.
The Azrieli Faculty of Medicine, Bar Ilan University, Zefat 1311502, Israel.
J Clin Med. 2023 Jan 17;12(3):745. doi: 10.3390/jcm12030745.
The complete left bundle branch block (CLBBB) results in ventricular dyssynchrony and a reduction in systolic and diastolic efficiency. We noticed a distinct clockwise rotation of the left ventricle (LV) in patients with CLBBB ("longitudinal rotation").
The aim of this study was to quantify the "longitudinal rotation" of the LV in patients with CLBBB in comparison to patients with normal conduction or complete right bundle branch block (CRBBB).
Sixty consecutive patients with normal QRS, CRBBB, or CLBBB were included. Stored raw data DICOM 2D apical-4 chambers view images cine clips were analyzed using EchoPac plugin version 203 (GE Vingmed Ultrasound AS, Horten, Norway). In EchoPac-Q-Analysis, 2D strain application was selected. Instead of apical view algorithms, the SAX-MV (short axis-mitral valve level) algorithm was selected for analysis. A closed loop endocardial contour was drawn to initiate the analysis. The "posterior" segment (representing the mitral valve) was excluded before finalizing the analysis. Longitudinal rotation direction, peak angle, and time-to-peak rotation were recorded.
All patients with CLBBB ( = 21) had clockwise longitudinal rotation with mean four chamber peak rotation angle of -3.9 ± 2.4°. This rotation is significantly larger than in patients with normal QRS (-1.4 ± 3°, = 0.005) and CRBBB (0.1 ± 2.2°, = 0.00001). Clockwise rotation was found to be correlated to QRS duration in patients with the non-RBBB pattern. The angle of rotation was not associated with a lower ejection fraction or the presence of regional wall abnormalities.
Significant clockwise longitudinal rotation was found in CLBBB patients compared to normal QRS or CRBBB patients using speckle-tracking echocardiography.
完全性左束支传导阻滞（CLBBB）会导致心室不同步，并降低收缩和舒张效率。我们注意到CLBBB患者的左心室（LV）存在明显的顺时针旋转（“纵向旋转”）。
本研究的目的是与正常传导或完全性右束支传导阻滞（CRBBB）患者相比，量化CLBBB患者LV的“纵向旋转”。
纳入60例连续的QRS正常、CRBBB或CLBBB患者。使用EchoPac插件版本203（挪威霍滕的GE Vingmed超声公司）分析存储的原始数据DICOM二维心尖四腔视图图像电影片段。在EchoPac-Q分析中，选择二维应变应用。分析时选择SAX-MV（短轴-二尖瓣水平）算法，而非心尖视图算法。绘制闭环心内膜轮廓以启动分析。在完成分析前排除“后”段（代表二尖瓣）。记录纵向旋转方向、峰值角度和达到峰值旋转的时间。
所有CLBBB患者（n = 21）均有顺时针纵向旋转，四腔平均峰值旋转角度为-3.9±2.4°。这种旋转明显大于QRS正常患者（-1.4±3°，P = 0.005）和CRBBB患者（0.1±2.2°，P = 0.00001）。发现非右束支传导阻滞模式患者的顺时针旋转与QRS时限相关。旋转角度与较低的射血分数或局部室壁异常的存在无关。
使用斑点追踪超声心动图发现，与QRS正常或CRBBB患者相比，CLBBB患者存在明显的顺时针纵向旋转。
